[Virtual Presenter] Welcome everyone to this presentation on the requirements, standards, and documentation procedures for providing physical therapy services. Today, our focus will be on the P-C-I-S-P and the importance of appropriate assessment and authorization for these services. To begin with, let us first understand what we mean by PCISP. This is a comprehensive document that outlines the requirements and standards for providing physical therapy services under the F-S-W and C-I-H waivers. Our presentation will focus on the reimbursable activities for physical therapy services. These include screening and assessment, treatment and training programs, direct therapeutic intervention, training and assistance with adaptive aids and devices, and consultation or demonstration of techniques with other service providers and family members. We also have specific documentation standards that must be met. Physical therapy services documentation must include documentation by appropriate assessment. This ensures that the need for these services is justified and authorized in the PCISP. Finally, we have service standards that apply to physical therapy. It is mandatory for individual physical therapy services to be reflected in the PCISP, regardless of the funding source. This emphasizes the importance of proper documentation and authorization of these services. In conclusion, our presentation outlines the necessary guidelines for providing physical therapy services under the F-S-W and C-I-H waivers. It is important to adhere to these guidelines and ensure proper documentation and authorization for the benefit of the individual receiving these services. Thank you for your attention, and please stay tuned for the remaining slides of this presentation.. 

Scene 1

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
131 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 10.19: Physical Therapy for FSW and CIH 
Waivers 
The following subsections provide information and requirements for Physical Therapy services for the 
FSW and CIH Waiver. 
Service Definition 
Physical Therapy services are services provided by a licensed physical therapist. 
These services cannot be provided as a substitute for services offered under the Indiana Medicaid State 
Plan. 
This waiver service is only provided to individuals ages 21 and over. All medically necessary Physical 
Therapy services for children under the age of 21 are covered in the state plan benefit pursuant to the 
EPSDT benefit. 
Reimbursable Activities 
Reimbursable activities include the following: 
• Screening and assessment 
• Treatment and training programs designed to preserve and improve abilities for independent 
functioning, such as gross and fine motor skills, range of motion, strength, muscle tone, and 
activities of daily living 
• Planning, reporting and write-up when in association with the actual one-on-one direct care/therapy 
service delivery with the waiver individual 
• Direct therapeutic intervention 
• Training and assistance with adaptive aids and devices 
• Consultation or demonstration of techniques with other service providers and family members 
Service Standards 
The following service standards apply to Physical Therapy: 
• Individual Physical Therapy services must be reflected in the PCISP, regardless of the funding 
source. 
• The need for such services must be documented by an appropriate assessment and authorized in the 
PCISP. 
Documentation Standards 
Physical Therapy services documentation must include the following: 
• Documentation by appropriate assessment 
• Services provided under both the Indiana Medicaid State Plan and the waiver must be outlined in 
the PCISP 
• Appropriate credentials for service providers 
• Attendance record, therapist logs and chart detailing services provided, dates and times

[Audio] Welcome to our presentation on the requirements, standards, and documentation procedures for providing physical therapy services. In this section, we will discuss the P-C-I-S-P and the need for appropriate assessment and authorization. It's important to note that this waiver service is only available to individuals aged 21 and over. Children under the age of 21 can receive medically necessary physical therapy services through the Indiana Medicaid State Plan. When billing for therapy services, a minimum of 45 minutes of direct individual care must be provided within one hour. The following activities are not allowed under physical therapy: therapy services within an educational or school setting, activities delivered in a nursing facility, and services already covered under the Indiana Medicaid State Plan. In order to receive reimbursement through the waiver, a Medicaid State Plan PA denial is required. To become a provider for physical therapy services under the waiver, you must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. Additionally, you must comply with the Indiana Administrative Code. Thank you for joining us for this overview of the requirements, standards, and procedures for providing physical therapy services. We hope this information has been helpful and we look forward to answering any questions you may have.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
132 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Documentation in compliance with 460 IAC 6 Supported Living Services and Supports 
requirements 
• Documentation of this service being requested on Indiana Medicaid State Plan shall be included in 
the PCISP 
As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case 
management system by the chosen service provider on or before the 15th day of the following month. 
Limitations 
This waiver service is only provided to individuals ages 21 and over. All medically necessary Physical 
Therapy services for children under age 21 are covered in the Indiana Medicaid State Plan benefit pursuant 
to the EPSDT benefit. 
One hour of billed therapy service must include a minimum of 45 minutes of direct individual care, with 
the balance of the hour spent in related individual services. 
Activities Not Allowed 
The following activities are not allowed under Physical Therapy: 
• Therapy services furnished to the individual within the educational/school setting or as a component 
of the individual’s school day 
• Activities delivered in a nursing facility 
• Services available through the Indiana Medicaid State Plan (a Medicaid State Plan PA denial is 
required before reimbursement is available through the waiver for this service) 
• Services provided by the parent of a minor child participant or the spouse of a participant (also 
known as LRIs) 
Note:  Therapies provided through this service will not duplicate therapies provided under 
any other service. 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-5-18 Physical Therapy Services Provider Qualifications 
• Must comply with any applicable BDS service standards, guidelines, policies and/or manuals, 
including FSSA DDRS policies and this module, accessible from the IHCP Provider Reference 
Modules page at in.gov/medicaid/providers 
• Where licensure/certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification

[Audio] We will discuss the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Specifically, we will focus on the P-C-I-S-P and the importance of appropriate assessment and authorization. This slide falls under Section 10 of the DDRS HCBS waivers, which covers service definitions and requirements for F-S-W and C-I-H waivers. We will be looking at Section 10.20, which deals with Prevocational Services for F-S-W and C-I-H waivers. Prevocational Services are supports that prepare individuals for paid employment and are intended to be a time-limited service along the continuum of employment supports. The purpose of these services is to develop or improve job and non-job skills, and increase preparedness for competitive integrated employment through learning and work experiences. These services must be prevocational in nature and not vocational, meaning they do not focus on specific job tasks but rather on achieving a generalized result. They may also include activities aimed at underlying habilitative goals rather than teaching specific job skills. Participants in this service are compensated at less than 50% of the minimum wage. It is important to document the use of Prevocational Services and ensure that they support the individual's stated employment outcomes in their PCISP. The ultimate goal of these services is to develop and teach general skills that will lead to competitive and integrated employment, such as effective communication with supervisors, coworkers, and customers, and generally accepted community workplace conduct. Thank you for listening to this overview of Prevocational Services for F-S-W and C-I-H waivers. Stay tuned for the next slide.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
133 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 10.20: Prevocational Services for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Prevocational Services for the FSW 
and CIH Waiver. 
Service Definition 
Prevocational Services are supports that prepare an individual for paid employment and are intended to be a 
time-limited service along the continuum of employment supports. Prevocational Services develop or 
improve job and non-job skills and increase preparedness to have a job in a competitive integrated setting 
through learning and work experiences, including volunteer work. This service is ideal for individuals 
newly exploring a possible interest in Competitive Integrated Employment (CIE) or who hope to develop, 
general, non-job-task-specific strengths and skills that contribute to employability in integrated community 
settings. 
Activities within this service must be prevocational rather than vocational in nature. A service is 
determined to be prevocational when one of the following occurs: 
• Services are not job-task oriented but are, instead, aimed at a generalized result. 
• Services include activities that are not primarily directed at teaching specific job skills but at 
underlying habilitative goals 
• Participants are compensated at less than 50% of the minimum wage. 
The use of Prevocational Services must be documented and support the individual’s stated employment 
outcomes in their PCISP. 
Prevocational Services are intended to develop and teach general skills that lead to competitive and 
integrated employment including: 
• Ability to communicate effectively with supervisors, coworkers and customers 
• Generally accepted community workplace conduct and dress 
• Ability to follow directions 
• Ability to attend to tasks 
• Workplace problem solving skills and strategies 
• General workplace safety and mobility training 
This service is part of a continuum of services that may lead to competitive integrated employment. 
Personal care/assistance is not a component of Prevocational Services. 
Prevocational Services may be delivered in a facility setting or a community setting, using an off-site 
enclave or mobile community work crew models. See Table 3 – Medicaid Waiver Services, Codes and 
Rates for FSW and CIH Waiver for the appropriate modifiers to use when billing for services provided in 
each of these settings. 
Facility settings are defined as nonresidential, nonintegrated settings that take place within the same 
building(s) for the duration of the service rather than being out in the community. Community settings are 
defined as nonresidential, integrated settings that are primarily out in the community where services are not 
rendered within the same building(s) alongside other nonintegrated individuals.

[Audio] Today, we will be discussing a document that outlines the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. The focus of our discussion will be on the P-C-I-S-P and the need for appropriate assessment and authorization. In Section 10, titled Service Definitions and Requirements for F-S-W and C-I-H Waivers, several reimbursable activities under Prevocational Services are listed. These include monitoring, training, education, demonstration, or support to assist individuals in acquiring and retaining skills in areas such as paid and unpaid training at less than 50% of the federal minimum wage, as well as generalized and transferrable employment skills acquisition. These activities can be provided through offsite enclave or mobile community work crew models. It is important to note that all Prevocational Services must be reflected in the PCISP. Additionally, these services should be reflected in the individual's plan of care as directed to habilitative rather than explicit employment objectives. This means that the focus is on developing skills and abilities rather than immediate employment opportunities. It is not expected that an individual will be able to join the general workforce or participate in sheltered employment within one year of receiving Prevocational Services. It is a process and progress towards these goals will be carefully monitored and documented. Speaking of documentation, it is crucial that Prevocational Services documentation includes the services outlined in the PCISP. In addition to this, compliance with documentation requirements outlined in 460 IAC 6 is necessary. This includes specific data elements such as the name and I-H-C-P Member ID of the individual receiving services, the name of the provider, the service rendered, the time frame of service, and the date of service including the year. It is also important to note the primary location of service delivery and provide a brief activity summary of the service rendered. Furthermore, direct care staff must document any issues or circumstances concerning the individual. Thank you for your attention to these service and documentation standards for Prevocational Services under the F-S-W and C-I-H waivers. Please continue to follow along as we discuss the remaining sections of the document. Thank you.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
134 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Reimbursable Activities 
Reimbursable activities under Prevocational Services include the following: 
• Monitoring, training, education, demonstration or support provided to assist with the acquisition and 
retention of skills in the following areas: 
– Paid and unpaid training compensated at less than 50% of the federal minimum wage 
– Generalized and transferrable employment skills acquisition 
• These activities may be provided using offsite enclave or mobile community work crew models. 
Service Standards 
The following service standards apply to Prevocational Services: 
• Prevocational Services must be reflected in the PCISP. 
• All Prevocational Services will be reflected in the individual’s plan of care as directed to habilitative 
rather than explicit employment objectives. 
• The individual is not expected to be able to join the general workforce or participate in sheltered 
employment within one year. 
Documentation Standards 
Prevocational Services documentation must include the following: 
• Services outlined in the PCISP 
• In addition to compliance with documentation requirements outlined in 460 IAC 6, the following 
data elements are required for each service rendered: 
– Name of individual served 
– IHCP Member ID (also known as RID) of the individual 
– Name of provider 
– Service rendered 
– Time frame of service (include a.m. or p.m.) 
– Date of service including the year 
– Notation of the primary location of service delivery 
– A brief activity summary of service rendered 
– In addition to the brief activity summary of service rendered, a description by direct care staff of 
any issue or circumstance concerning the individual including, but not limited to, significant 
medical or behavioral incidents or any other situation that may be uncommon for the individual 
– Signature that includes at least the last name and first initial of the direct care staff person 
making the entry (Electronic signatures are permissible when in compliance with the Uniform 
Electronic Transactions Act [IC 26-2-8].) 
Upon request, all data elements must be made available to auditors, quality monitors, case managers and 
any other government entity. The documentation may reside in multiple locations but must be clearly and 
easily linked to the individual or the standard will not be met. 
As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case 
management system by the chosen service provider on or before the 15th day of the following month.

[Audio] We are discussing the requirements for F-S-W and C-I-H Waivers Physical Therapy Services under the DDRS HCBS Waivers. There are specific guidelines and procedures for providing physical therapy services. These include the PCISP, which focuses on appropriate assessment and authorization. For Group Services, the provider must ensure that the ratio for each claimed time frame of service does not exceed the maximum allowable ratio, regardless of whether all group individuals are using a waiver funding stream. There are limitations on group sizes for Prevocational Services, with small groups having a ratio of 4:1 or smaller, medium groups having a ratio of 5:1 to 10:1, and larger groups having a ratio of larger than 10:1 but no larger than 16:1. This is a time-limited service, with a maximum of 18 months throughout a participant's time on the waiver. Exceptions to this limit will only be made on a case-by-case basis after careful consideration and alignment with the participant's individualized transition plan. Any extension of the service beyond 18 months must be accompanied by a plan for transitioning to competitive, integrated employment or another appropriate waiver service. This plan will be revisited and updated by the individual and their Individualized Support Team (I-S-T--) at least every six months, with progress toward transition as a necessary precursor for an extension. Monitoring occurs on a quarterly basis, including assessing progress towards employment goals, evaluating the appropriateness of the service, and seeking input from the individual's ISt The main objective of monitoring is to assess the individual's progress towards achieving the outcomes outlined in their P-C-I-S-P related to employment and to verify the continued need for Prevocational Services. It is important to stay informed and adhere to these guidelines for the best care and support of our participants.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
135 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
For Group Services 
Upon request, the provider must be able to verify in a concise format that the ratio for each claimed time 
frame of service did not exceed the maximum allowable ratio, whether or not all group individuals use a 
waiver funding stream.  
Limitations 
The following are limitations on group sizes (individuals: staff) for Prevocational Services: 
• Small (4:1 or smaller) 
• Medium (5:1 to 10:1) 
• Larger (larger than 10:1 but no larger than 16:1) 
This is a time-limited service that can be accessed by a given participant for a total of no more than 18 
months throughout their time on this waiver. Exceptions to this limit will be made on a case-by-case basis 
by the state following the state’s determination that exceeding this limit is clearly in alignment with the 
participant's individualized transition plan. Any provision of this service for longer than 18 months must be 
accompanied by a plan for transitioning, which will be revisited and updated by the individual and their 
IST at least every six months with progress toward transition to competitive, integrated employment or 
another appropriate waiver service being a necessary precursor for an extension. 
Monitoring of Prevocational Services occurs on a quarterly basis. Monitoring should include the 
assessment of progress toward employment goals, the appropriateness of the service and input from the 
individualized support team lead by the individual. The objectives of monitoring include assessment of the 
individual’s progress toward achieving the outcomes identified on the individual’s PCISP related to 
employment and to verify the continued need for Prevocational Services. The appropriateness of 
Prevocational Services is determined by dividing the previous quarter’s gross earnings by the hours of 
attendance. 
If the hourly wage falls below 50% of the federal minimum wage, Prevocational Services may be 
continued. If the average wage exceeds 50% of the federal minimum wage, Prevocational Services should 
be discontinued for the next quarter and, when chosen by the individual, should be replaced with 
competitive integrated employment options, volunteer work experiences and/or supports that develop job 
specific tasks related to the individual’s employment outcomes. 
Activities Not Allowed 
The following activities are not allowed under Prevocational Services: 
• Services that are available under the Rehabilitation Act of 1973 or section 602 (16) and (17) of the 
Individuals with Disabilities Education Act 
• Activities that do not foster the acquisition and retention of skills 
• Services in which compensation is greater than 50% of the federal minimum wage 
• Activities directed at teaching specific job skills 
• Sheltered employment, facility-based 
• Services provided by the parents, stepparents, or legal guardians of a minor child participant or the 
spouse of a participant (also known as LRIs)

[Audio] We are currently on slide 14 of the presentation, discussing the necessary requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Our focus today is on the P-C-I-S-P and the importance of appropriate assessment and authorization. To begin, we will be talking about the qualifications required for physical therapy providers under these waivers. These providers must meet the following criteria: Be actively enrolled as a Medicaid provider Be approved by F-S-S-A D-D-R-S Comply with the guidelines set by Indiana Administrative Code, 460 I-A-C 6, including but not limited to: documentation of criminal histories, insurance, and financial status of providers. Additionally, they must also adhere to any applicable B-D-S service standards, guidelines, policies, and/or manuals, including FSSA DDRS policies and the module accessible on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. Furthermore, they must obtain and maintain accreditation from at least one of the following organizations: The Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-) or its successor The Council on Quality and Leadership in Supports for People with Disabilities or its successor The Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O) or its successor The National Committee for Quality Assurance or its successor The ISO-9001 human services quality assurance (Q-A---) system An independent national accreditation organization approved by the F-S-S-A Secretary Aside from discussing the provider qualifications, we will also touch upon the requirements for psychological therapy services under the F-S-W and C-I-H waivers. These services are provided by a licensed psychologist with an endorsement as a health service provider in psychology (H-S-P-P-), a licensed marriage and family therapist, a licensed clinical social worker, or a licensed mental health counselor. It's important to note that these services cannot be used as a substitute for those offered under the Indiana Medicaid State Plan. These waiver services are only available to individuals aged 21 and above, while medically necessary Psychological Therapy services for children under 21 are covered under the state plan benefit in accordance with the E-P-S-D-T benefit. To conclude, we will provide a summary of the key points discussed and answer any questions you may have. Thank you for joining us for this presentation.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
136 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-5-20 Prevocational Services Provider Qualifications 
– 460 IAC 6-14-5 Requirements for Direct Care Staff 
– 460 IAC 6-14-4 Training 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Provider Reference Modules page 
at in.gov/medicaid/providers 
• Must obtain/maintain accreditation (specific to Indiana programs) by at least one of the following 
organizations: 
– The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor 
– The Council on Quality and Leadership In Supports for People with Disabilities, or its successor 
– The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor 
– The National Committee for Quality Assurance, or its successor 
– The ISO-9001 human services quality assurance (QA) system 
– An independent national accreditation organization approved by the FSSA Secretary 
Section 10.21: Psychological Therapy for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Psychological Therapy services for 
the FSW and CIH Waiver. 
Service Definition 
Psychological Therapy services are services provided by a licensed psychologist with an endorsement as a 
health service provider in psychology (HSPP), a licensed marriage and family therapist, a licensed clinical 
social worker or a licensed mental health counselor. 
These services cannot be provided as a substitute for services offered under the Indiana Medicaid State 
Plan. 
This waiver service is only provided to individuals ages 21 and over. All medically necessary Psychological 
Therapy services for children under age 21 are covered in the state plan benefit pursuant to the EPSDT 
benefit.

[Audio] We are now on our seventh slide of our presentation, where we will be discussing the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Our focus will be on the P-C-I-S-P and the need for appropriate assessment and authorization. Under the DDRS HCBS waivers, there are certain reimbursable activities for Psychological Therapy. These include individual counseling, biofeedback, individual-centered therapy, cognitive behavioral therapy, psychiatric services, crisis counseling, family counseling, group counseling, substance abuse counseling and intervention. Additionally, planning, reporting, and write-up are also reimbursable when in association with the actual one-on-one direct care or therapy service delivery with the waiver individual. It is important to note that therapy services should be reflected in the P-C-I-S-P of the individuals regardless of the funding source. This means that regardless of whether the service is under the Indiana Medicaid State Plan or the waiver, it must be included in the PCISP. Furthermore, these services must address the needs identified in the person-centered planning process and must complement other services received by the individuals, with the ultimate goal of increasing independence. Moving on to documentation standards, it is crucial that all Psychological Therapy services are properly documented. This includes appropriate assessments, outlining services in the PCISP, and providing the necessary credentials for the service provider. In addition, attendance records, therapist logs, and/or charts must be kept to detail the services provided, dates, and times. It is also important to ensure that all documentation is in compliance with 460 IAC 6 Supported Living Services and Supports requirements. And finally, for those services requested on the Indiana Medicaid State Plan, it is imperative that they are also included in the PCISP. Lastly, it is important to note that as applicable, monthly or quarterly reports must be uploaded to the document library of the state's case management system by the chosen service provider on or before the 15th day of the month. This is to ensure that all documentation is up to date and in compliance with the necessary standards.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
137 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Reimbursable Activities 
Reimbursable activities under Psychological Therapy include the following: 
• Individual counseling 
• Biofeedback 
• Individual-centered therapy 
• Cognitive behavioral therapy 
• Psychiatric services 
• Crisis counseling 
• Family counseling 
• Group counseling 
• Substance abuse counseling and intervention 
• Planning, reporting and write-up when in association with the actual one-on-one direct care/therapy 
service delivery with the waiver individual 
Service Standards 
The following service standards apply to Psychological Therapy: 
• Therapy services should be reflected in the PCISP of the individuals regardless of the funding 
source. 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. 
• Services must complement other services the individuals receive and enhance increasing 
independence for the individual. 
Documentation Standards 
Psychological Therapy services documentation must include the following: 
• Documentation by appropriate assessment 
• Services provided under both the Indiana Medicaid State Plan and the waiver must be outlined in 
the PCISP 
• Appropriate credentials for service provider 
• Attendance record, therapist logs and/or charts detailing services provided, dates and times 
• Documentation in compliance with 460 IAC 6 Supported Living Services and Supports 
requirements 
• Documentation of this service being requested on Indiana Medicaid State Plan shall be included in 
the PCISP 
As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case 
management system by the chosen service provider on or before the 15th day of the following month.

[Audio] We continue our discussion on the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Now, we turn our attention to Section 10, which focuses on service definitions and limitations. It's important to note that this waiver service is only available to individuals ages 21 and over. Any medically necessary psychological therapy services for children under the age of 21 are covered by the Indiana Medicaid State Plan benefit under the E-P-S-D-T program. When it comes to billing for therapy services, it's important to remember that one hour of billed therapy must include a minimum of 45 minutes of direct individual care, with the remaining 15 minutes spent on related patient services. However, there are certain activities that are not allowed under Psychological Therapy. This includes activities delivered in a nursing facility, services already covered under the Indiana Medicaid State Plan (which requires a Medicaid State Plan PA denial before reimbursement can be obtained through the waiver), and therapy services provided within an educational or school setting. It's also worth noting that services provided by the parent of a minor child or the spouse of a participant, also known as L-R-I-s-, are not allowed. This service is specifically designed to prevent duplication of therapies provided under any other service. Therefore, it is crucial that providers comply with the following qualifications. First and foremost, providers must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with Indiana Administrative Code, 460 I-A-C 6, which includes documentation of criminal histories, insurance requirements, and financial status. Additionally, providers must meet any applicable B-D-S service standards, guidelines, and policies, including FSSA DDRS policies and this module. It's important for providers to review and fully understand these qualifications to ensure quality and appropriate services are provided to individuals. Thank you for listening and don't hesitate to reach out to us for any further clarification.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
138 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Limitations 
This waiver service is only provided to individuals ages 21 and over. All medically necessary 
Psychological Therapy services for children under age 21 are covered in the Indiana Medicaid State Plan 
benefit pursuant to the EPSDT benefit. 
One hour of billed therapy service must include a minimum of 45 minutes of direct individual care with the 
balance of the hour spent in related patient services. 
Activities Not Allowed 
The following activities are not allowed under Psychological Therapy: 
• Activities delivered in a nursing facility 
• Services that are available through the Indiana Medicaid State Plan (a Medicaid State Plan PA 
denial is required before reimbursement is available through the Medicaid waiver for this service) 
• Therapy services furnished to the individual within the educational/school setting or as a component 
of the individual’s school day 
• Service provided by the parent of a minor child participant or the spouse of a participant (also 
known as LRIs) 
Note: Therapies provided through this service will not duplicate therapies provided under 
any other service. 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-5-21 Therapy Services Provider Qualifications 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Provider Reference Modules page 
at in.gov/medicaid/providers 
• Where licensure/certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification: 
– For a clinical social worker, meet requirements set forth in IC 25-23.6  
– For a licensed psychologist, meet requirements set forth in IC 25-33-1-5.1 
– For a marriage/family therapist, meet requirements set forth in IC 25-23.6 
– For a mental health counselor, meet requirements set forth in IC 25-23.6

[Audio] We will discuss the requirements and standards for providing physical therapy services under the F-S-W and C-I-H waivers, which is covered in slide 9 of our presentation. We will focus on the P-C-I-S-P and the importance of appropriate assessment and authorization. Recreational Therapy services fall under section 10.22 of the DDRS HCBS waivers, with a service definition outlined in 460 I-A-C 6-3-43. These services aim to restore, remediate, or rehabilitate an individual's functioning and independence, as well as reduce or eliminate the effects of their disability. Examples of reimbursable activities under Recreational Therapy include organizing and directing adapted sports, dramatics, arts and crafts, and social activities. Planning, reporting, and write-up services are also reimbursable when conducted in association with the actual one-on-one direct care/therapy service delivery with the waiver individual. We have set certain service standards for Recreational Therapy to ensure quality services for our clients. These standards should be reflected in the P-C-I-S-P and address the needs identified in the person-centered planning process. Furthermore, these services should complement other services the individual receives and promote increasing independence. Documentation standards for Recreational Therapy services include appropriate assessment, outlining services in PCISP, and providing appropriate credentials for the service provider. An attendance record should also be maintained. Thank you for your attention to this important information regarding Recreational Therapy services for the F-S-W and C-I-H waivers. On the next slide, we will discuss the documentation standards for other services provided under the Indiana Medicaid State Plan and the waiver.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
139 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 10.22: Recreational Therapy for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Recreational Therapy services for the 
FSW and CIH Waiver. 
Service Definition 
Recreational Therapy services are services provided under 460 IAC 6-3-43 and consisting of a medically 
approved recreational program to restore, remediate or rehabilitate an individual to: 
• Improve the individual’s functioning and independence 
• Reduce or eliminate the effects of individual’s disability 
Reimbursable Activities 
Reimbursable activities under Recreational Therapy services include the following: 
• Organizing and directing adapted sports, dramatics, arts and crafts, social activities, and other 
recreation services designed to restore, remediate or rehabilitate 
• Planning, reporting and write-up when in association with the actual one-on-one direct care/therapy 
service delivery with the waiver individual 
• Individual services 
Service Standards 
The following service standards apply to Recreational Therapy: 
• Recreational Therapy services, regardless of funding source, should be reflected in the PCISP. 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. 
• Services must complement other services the individual receives and enhance increasing 
independence for the individual. 
Documentation Standards 
Recreational Therapy services documentation must include the following: 
• Documentation by appropriate assessment 
• Services provided under both the Indiana Medicaid State Plan and the waiver must be outlined in 
PCISP 
• Appropriate credentials for service provider 
• Attendance record, therapist logs and/or charts detailing services provided, dates and times 
• Documentation in compliance with 460 IAC 6 Supported Living Services and Supports requirements 
• Documentation of this service being requested on Indiana Medicaid State Plan shall be included in 
the PCISP 
As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case 
management system by the chosen service provider on or before the 15th day of the following month.

[Audio] We will discuss the service definitions and requirements for both F-S-W and C-I-H waivers, with a specific focus on P-C-I-S-P and appropriate assessment and authorization. Within this section, we will also mention Recreational Therapy services. However, there are limitations to these services that need to be understood. Firstly, services provided under the waiver cannot be used as a substitute for those covered under the Indiana Medicaid State Plan, ensuring that individuals receive the necessary and appropriate care for their specific needs. Additionally, group services are limited to a maximum of four individuals per recreational therapist, determined by dividing the unit rate by the number of individuals served. One hour of billed therapy service must include at least 45 minutes of direct individual care, with the remaining time spent on related individual services. Certain activities such as payment for the cost of recreational activities, registrations, memberships, or admission fees associated with the planned, organized, or directed activities are not allowed as part of Recreational Therapy. Any services that are already reimbursable through the Indiana Medicaid State Plan are not covered under this waiver. Furthermore, therapy services cannot be provided within the educational or school setting or as a component of an individual's school day. The size of group services should not exceed the maximum allowable group size determined by the Interdisciplinary Support Team (I-S-T--) for each individual in the group. Group services should only be provided when the I-S-T has determined it to be appropriate for each individual in the group, ensuring that individuals receive the most effective and personalized care. Providers of Recreational Therapy services must meet certain qualifications, including being enrolled as an active Medicaid provider and being FSSA DDRS-approved. Providers must also comply with the Indiana Administrative Code, specifically 460 I-A-C 6-10-5 D Thank you for your attention to this important information regarding Recreational Therapy services under the F-S-W and C-I-H waivers. By following these guidelines and limitations, we can ensure that individuals receive the best possible care and support.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
140 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Limitations 
Recreational Therapy service has the following limitations: 
• Services provided under the waiver cannot be used as a substitute for services that are provided 
under the Indiana Medicaid State Plan. 
• Group services in group sizes no greater than four individuals to one recreational therapist (unit rate 
divided by number of individuals served). 
• One hour of billed therapy service must include a minimum of 45 minutes of direct individual care 
with the balance of the hour spent in related individual services. 
Activities Not Allowed 
The following activities are not allowed as part of Recreational Therapy: 
• Payment for the cost of the recreational activities, registrations, memberships or admission fees 
associated with the activities being planned, organized or directed 
• Any services that are reimbursable through the Indiana Medicaid State Plan 
• Therapy services furnished to the individual within the educational/school setting or as a component 
of the individual’s school day 
• Group sizes greater than four individuals to one recreational therapist or group sizes exceeding the 
maximum allowable group size determined by the IST for each group individual  
• Group services when group settings were not determined to be appropriate by the IST for each 
group individual 
• This service will not be reimbursed when provided by the parent of a minor child participant or the 
spouse of a participant (also known as LRIs) 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and Insurance 460 IAC 6-12-2 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-5-22 Recreational Therapy Services Provider Qualifications 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Provider Reference Modules page 
at in.gov/medicaid/providers. 
Section 10.23: Remote Supports for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Remote Supports services for the 
FSW and CIH Waiver.

[Audio] We are now on slide number 11, out of 14, in our presentation on the DDRS HCBS Waivers. This slide covers the service definition and requirements of Remote Supports for F-S-W and C-I-H Waivers. Remote Supports is a comprehensive service that uses technology-based tools to provide live support to individuals from a remote location. This allows trained remote support professionals, or R-S-P-s-, to assist individuals instead of being on-site. The main responsibility of R-S-Ps is to provide Remote Supports from a secure remote support facility provided by the provider. To ensure the safety and confidentiality of our clients, this facility must have stable and redundant connections, including backup generators, multiple internet service connections, and battery backups. Remote Supports also includes oversight and monitoring within the residential setting for adult waiver participants and minors aged 14 to 17, through the use of technology such as two-way communication systems and sensors. It is important to note that for minors, Remote Supports are used to encourage appropriate independence, not to replace parental supervision. The ultimate goal of Remote Supports is to promote independence and security for our clients by combining technology and services to provide direct contact with trained staff whenever needed. This fosters a sense of security and allows for the development of life skills and increased independence. For those who are transitioning to independent living, Remote Supports can also assist in this process by enhancing self-advocacy skills and providing opportunities for community participation. It is important to note that Remote Supports can be used with both paid and unpaid backup support, as specified in the F-S-W and C-I-H Waivers. This ensures that our clients have the necessary support to live independently while maintaining their sense of security. Thank you for listening to this overview of Remote Supports. We will now move on to our next topic, and please feel free to ask any questions during the Q&A session at the end of the presentation.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
141 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Service Definition 
Remote Supports includes a wide range of technology-based services that allows for trained remote support 
professionals (RSPs) to deliver live support to an individual from a remote location in place of on-site 
staffing. Remote Supports are delivered by awake and alert remote support professionals whose primary 
duties are to provide Remote Supports from the provider’s secure remote supports facility. To ensure safety 
and HIPAA compliance, this facility should have appropriate, stable and redundant connections. This 
should include, but is not limited to, backup generators, multiple internet service connections, battery 
backups and so on.  
Remote Supports include the provision of oversight and monitoring within the residential setting of adult 
waiver participants and individuals 14 to 17 years of age through the use of technology, two-way 
communication systems and sensors. For minors, Remote Supports are used to foster developmentally 
appropriate independence and not to replace typical parental supervision.  
Remote support services foster independence and security by combining technology and service to allow 
for direct contact with trained staff when the individual needs. Remote Supports provide a realistic, non-
invasive way for individuals to build life skills and familiarity in their level of independence with a sense of 
security. Remote Supports can assist individuals to live more independently or support a safe transition to 
independent living while enhancing their self-advocacy skills and increase opportunities for participating in 
the community. 
Remote Supports may be used with either paid or unpaid backup support as specified in the individual’s 
service plan. Backup support is when a trained person is responsible for responding in-person/on-site in the 
event of an emergency or when an individual receiving Remote Supports otherwise needs assistance or the 
equipment used for delivery of Remote Supports stops working for any reason.  
Paid backup support is provided on a paid basis by a provider of residential habilitation and support (CIH 
Waiver) or participant assistance and care (Family Supports Waiver or FSW) that is both the primary point 
of contact for the remote supports vendor and the entity to send paid staff persons on-site when needed.  
Unpaid backup support may be provided by a family member, friend or other person who the individual 
chooses. 
The person-centered individualized support plan (PCISP) will reflect how the Remote Supports are being 
used to meet the individual’s needs, vision for their good life, and health and welfare needs.  
Reimbursable Activities 
Reimbursable activities include the following: 
• Monitoring, oversight and support by the RSP.  
• Initial and ongoing training, education and technical assistance of paid and unpaid backup support 
intervention to prepare for prompt engagement with the individuals and/or immediate deployment to 
the residential setting. 
• Updates of remote support equipment and technology when the equipment and technology require 
regular information technology support. 
• Installation of remote supports equipment and technology is allowable in residential or family home 
settings or unpaid back up support person location when necessary to provide remote support 
services in place of on-site staffing.  
• When all service standards are met, the service provider shall be reimbursed at the full unit rate for 
each hour that the Remote Supports service is rendered.

[Audio] Assessment and informed consent are critical for the provision of physical therapy services under the DDRS HCBS waivers. Careful consideration and adherence to specific standards and requirements are necessary. As described in Section 10, the unit rate for Remote Supports services is divided among the number of waiver individuals present in the home during each hour of service. This only applies to individuals who have Remote Supports included in their plan. In addition to this, it is imperative that the remote support system is designed and implemented with the individual's independence, health, and safety in mind. The case manager and/or B-D-S service coordinator will conduct reviews at seven and 14 calendar days after the installation to ensure that the system meets these standards. The remote support service requires both assessment and informed consent. Informed consent must be obtained from the individual using the service, their guardian, and other individuals and their guardians residing in the home. This consent must clearly state the parameters in which the remote support service will be used. Moreover, all individuals, guardians, and I-S-T must be fully informed about the benefits and risks associated with the operating parameters and limitations of the remote support service. The remote support provider conducts an assessment, with input from the individual and their I-S-T--, to determine the best location for the devices or monitors to meet the individual's needs. The individual's personal control and use of the equipment will be reflected in their PCISP. It is the responsibility of the remote support provider to inform the individual of the equipment's operation and usage. Finally, all informed consent documents must be acknowledged in writing and signed and dated by the individual, guardian, case manager, and provider. It is crucial to ensure that assessment and informed consent are properly obtained and considered for the successful implementation of remote support services under the DDRS HCBS waivers.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
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Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
The unit rate for each hour of Remote Supports service utilization shall be divided by and among the 
number of waiver individuals present in the home during any portion of the hour for which reimbursement 
is requested.  
Dividing the unit rate by and among waiver individuals applies only to individuals for whom Remote 
Supports are included on the plan.  
Service Standards 
The remote supports system must be designed and implemented to ensure the individual’s independence, 
health and safety in their own home/apartment. 
Note: The case manager and/or the BDS service coordinator will review the use of the 
system at seven calendar days, and again at 14 calendar days postinstallation. 
Assessment and Informed Consent 
The following are key points regarding assessment and informed consent: 
• Informed consent: Informed consent by the individual using the service, their guardian and other 
individuals and their guardians residing in the home must be obtained and clearly state the 
parameters in which the remote support service would be used.  
• Each individual, guardian and IST must be made aware of both the benefits and risks of the 
operating parameters and limitations. Through an assessment by the remote support provider with 
input from the individual and their IST the location of the devices or monitors will be determined to 
best meet the individual’s needs.  
• The PCISP will reflect the individual’s control and use of the equipment. The individual must be 
informed by the Remote Support provider on the operation and use of the equipment.  
• Informed consent documents must be acknowledged in writing, signed and dated by the individual, 
guardian, case manager and provider agency representative, as appropriate. A copy of the consent 
shall be maintained by the local DDRS/BDS office, the guardian (if applicable) and in the home file. 
If the individual desires to withdraw consent, they would notify the case manager. As informed 
consent is a prerequisite for utilization of Remote Supports services, a meeting of the IST would be 
needed to discuss available options for any necessary alternate supports. All residing adult and 
youth individuals, their guardians and their support teams impacted by the decision to withdraw 
consent must be immediately informed of the decision and use of remote supports in the setting 
must be discontinued. PCISPs should reflect how individuals want to inform visitors of the use of 
remote supports in the setting if video monitoring is being used under this service. Use of the system 
may be restricted to certain hours through the PCISPs of the individuals involved. 
• Withdrawing consent: If the individual desires to withdraw consent, they would notify the case 
manager. As informed consent is a prerequisite for utilization of Remote Supports services, a 
meeting of the IST would be needed to discuss available options for any necessary alternative 
supports. All residing adult and youth individuals, their guardians and their support teams impacted 
by the decision to withdraw consent must be immediately informed of the decision and use of 
remote supports in the setting must be discontinued. 
• Use of the system may be restricted to certain hours through the PCISPs of the individuals involved. 
• PCISPs should reflect how individuals want to inform visitors of the use of remote supports in the 
setting if video monitoring is being used under this service.

[Audio] Moving on to slide number 13, we will be discussing the requirements and standards for providing physical therapy services under the DDRS HCBS waivers. Our focus will be on the P-C-I-S-P and the importance of appropriate assessment and authorization. In Section 10 of the presentation, we will outline the specific service definitions and requirements for the F-S-W and C-I-H waivers. When implementing a remote supports system to replace in-person direct support services, certain safeguards and backup procedures must be in place. Firstly, the provider is responsible for having backup systems (such as batteries and generators) to ensure that electronic devices remain functional during electrical outages. This applies to both the remote supports monitoring base and the individual's residential living sites. Additionally, there must be backup procedures in case of system failure, fire or weather emergencies, individual medical issues, or personal emergencies. These procedures should be documented for each site using the system, as well as for each individual's PCISP. It is crucial that these plans specify the staff members responsible for responding to these situations and traveling to the individual's living site, including any identified backup support responder. Furthermore, the remote supports system must be able to receive notifications from smoke or heat alarms at each individual's residential living site. This is essential for ensuring the safety and well-being of the individuals being monitored. In order to effectively interact with and address the needs of individuals in each living site, the remote supports system must have two-way audio communication capabilities. This is especially important in emergency situations where the individual may not be able to use the phone. Lastly, the system must allow the monitoring base staff to have visual oversight of specific areas in an individual's living site as deemed necessary by the ISt It is important to note that a remote supports monitoring base cannot be located in an individual's residential living site. This is to protect the privacy and independence of the individuals being monitored. Thank you for your attention, and now we can move on to the final slide of our presentation.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
143 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
System Design 
The following are requirements of a remote supports system design when used to replace in-person direct 
support service delivery: 
• The provider must have safeguards and/or backup system such as battery and generator for the 
electronic devices in place at the remote supports monitoring base and the individual’s residential 
living sites in the event of electrical outages. 
• The provider must have backup procedures for system failure (for example, prolonged power 
outage), fire or weather emergency, individual medical issue or personal emergency in place and 
detailed in writing for each site utilizing the system as well as in each individual’s PCISP. This plan 
should specify the staff person or persons to be contacted by remote support monitoring base staff 
who will be responsible for responding to these situations and traveling to the individual’s living 
sites, including any previously identified paid or unpaid backup support responder. 
• The remote supports system must receive notification of smoke/heat alarm activation at each 
individual’s residential living site. 
• The remote supports system must have two-way (at minimum, full duplex) audio communication 
capabilities to allow monitoring base staff to effectively interact with and address the needs of 
individuals in each living site, including emergency situations when the individual may not be able 
to use the telephone. 
• The remote supports system must allow the monitoring base staff to have visual (video) oversight of 
areas in individual’s residential living sites as deemed necessary by the IST. 
• A remote supports monitoring base may not be located in an individual’s residential living site. 
• A secure (compliant with the HIPAA) network system requiring authentication, authorization and 
encryption of data must be in place to ensure access to computer vision, audio, sensor or written 
information is limited to authorized staff including the parent/guardian, provider agency, FSSA, the 
DDRS, the BDS, the qualified intellectual disability professional (QIDP), case manager and 
individual.  
• The equipment must include a visual indicator to the individual that the system is on and operating. 
• For situations involving remote supports of individuals needing 24-hour support, if an individual 
indicates that they want the remote supports system to be turned off and wants in-person supports, 
the following protocol will be implemented: 
– The electronic caregiver will notify the provider to request an on-site staff or other previously 
identified paid or unpaid backup support responder. 
– The system would be left operating until the on-site staff or other previously identified paid or 
unpaid backup support responder arrives. 
– The electronic caregiver would turn off the system at that site after it has been relieved by an on-
site staff or other previously identified paid or unpaid backup support responder. 
– A visible light on the control box would signal when the system is on and when it is off. 
Remote Support Monitoring Base Staff  
The following are requirements for remote supports monitoring base staff when remote supports are used in 
place of in-person direct support service delivery: 
• At the time of monitoring, the remote supports monitoring base staff may not have duties other than 
the oversight and support of individuals at remote living sites. 
• The remote supports monitoring base staff will assess any urgent situation at an individual’s home 
and call 911 emergency personnel first, if it is deemed necessary, and then call the backup staff

[Audio] Our presentation is focused on the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers, with a specific emphasis on the P-C-I-S-P and the need for appropriate assessment and authorization. As we move to slide 14, we want to highlight the importance of real-time monitoring and backup support for individuals who receive services in their homes. The remote supports monitoring base staff will stay engaged with the individuals in their homes during urgent situations until backup staff or emergency personnel arrive. If computer vision or video is used, oversight must be done in real-time by an awake staff member at a remote location using telecommunications or broadband connections. The remote supports monitoring base must keep a file on each individual in each home monitored, including a current photograph and pertinent information to ensure their safety. This file must be updated at least annually. The remote supports monitoring base staff must also have detailed and up-to-date protocols for responding to the needs of each individual, including contact information for on-site support at their residential living site when necessary. As for backup support, the following are requirements: backup support must respond and arrive at the individual's residential living site within 20 minutes of the incident being identified by remote staff, and they must acknowledge receipt of the notification. The I-S-T has the authority to set a shorter response time based on the individual's needs. Backup support must be provided by one support person for on-site response, and the number of individuals served by that backup support must be determined by the I-S-T based on their assessed needs in specific locations. In cases where backup support is needed, they will assist the individual in their home until the urgent need or issue is resolved. If necessary, relief for backup support must be provided by the residential habilitation provider. In terms of documentation, the following must be included:. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
144 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
person. The remote supports monitoring base staff will stay engaged with the individuals at the 
home during an urgent situation until the backup staff or emergency personnel arrive. 
• If computer vision or video is used, oversight of an individual’s home must be done in real time by 
an awake staff at a remote location (remote monitoring base) using telecommunications/broadband, 
the equivalent or better, connection. 
• The remote supports monitoring base (remote station) shall maintain a file on each individual in 
each home monitored that includes a current photograph of each individual, which must be updated 
if significant physical changes occur, at least annually. The file shall also include pertinent 
information on each individual, noting facts that would aid in ensuring the individuals’ safety. 
• The remote supports monitoring base staff must have detailed and current written protocols for 
responding to the needs of each individual, including contact information for staff to supply on-site 
support at the individual’s residential living site, when necessary. 
Backup Support (Applicable to RHS Hourly and RHS Daily 
Services Under the CIH Waiver and PAC under the FSW) 
The following are requirements for stand-by intervention staff/backup support used with residential 
habilitation and support (RHS) hourly, RHS daily services (for CIH Waiver) and participant assistance and 
care (PAC) (for FSW): 
• The backup support shall respond and arrive at the individual’s residential living site within 20 
minutes from the time the incident is identified by the remote staff, and backup support 
acknowledges receipt of the notification by the remote monitoring base staff. The IST has the 
authority to set a shorter response time based on the individual individual’s need. 
• The service must be provided by one backup support for on-site response. The number of 
individuals served by the one backup support is to be determined by the IST, based upon the 
assessed needs of the individuals being served in specifically identified locations. 
• Backup support will assist the individual in the home as needed to ensure the urgent need/issue that 
generated an intervention response has been resolved. Relief of backup support, if necessary, must 
be provided by the residential habilitation provider. 
Documentation Standards 
Documentation must include the following: 
• A remote supports care plan must be developed/updated at least annually outlining how remote 
supports will be used. The care plan must be attached to the PCISP. 
• Every 90 days a report must be submitted within the DDRS system outlining the past quarter’s 
remote support activities including any suggested modifications or area of concern. These reports 
should be discussed, at minimum, during semi-annual and annual team meetings.  
• Services outlined in the PCISP: 
– To be reimbursed, the provider must prepare and be able to produce the following: 
➢ Status as a BDS-approved provider 
➢ Case notes regarding the assessment and approval by both the IST of each individual, 
documented within both the DDRS system and the PCISP 
➢ Informed consent documents written, signed, and dated by the individual, guardian, case 
manager and provider agency representative, as appropriate 
▪ Copies of consent documents maintained by the local BDS office, the case manager, the 
guardian (if applicable) and in the home file

 part 11

Welcome to our presentation on the requirements, standards, and documentation procedures for providing physical therapy services. In this section, we will discuss the P-C-I-S-P and the need for appropriate assessment and authorization.

It's important to note that this waiver service is only available to individuals aged 21 and over. Children under the age of 21 can receive medically necessary physical therapy services through the Indiana Medicaid State Plan. When billing for therapy services, a minimum of 45 minutes of direct individual care must be provided within one hour.

The following activities are not allowed under physical therapy: therapy services within an educational or school setting, activities delivered in a nursing facility, and services already covered under the Indiana Medicaid State Plan. In order to receive reimbursement through the waiver, a Medicaid State Plan PA denial is required.

To become a provider for physical therapy services under the waiver, you must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. Additionally, you must comply with the Indiana Administrative Code.

Thank you for joining us for this overview of the requirements, standards, and procedures for providing physical therapy services. We hope this information has been helpful and we look forward to answering any questions you may have.

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We will discuss the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Specifically, we will focus on the P-C-I-S-P and the importance of appropriate assessment and authorization. This slide falls under Section 10 of the DDRS HCBS waivers, which covers service definitions and requirements for F-S-W and C-I-H waivers. We will be looking at Section 10.20, which deals with Prevocational Services for F-S-W and C-I-H waivers. Prevocational Services are supports that prepare individuals for paid employment and are intended to be a time-limited service along the continuum of employment supports. The purpose of these services is to develop or improve job and non-job skills, and increase preparedness for competitive integrated employment through learning and work experiences. These services must be prevocational in nature and not vocational, meaning they do not focus on specific job tasks but rather on achieving a generalized result. They may also include activities aimed at underlying habilitative goals rather than teaching specific job skills. Participants in this service are compensated at less than 50% of the minimum wage. It is important to document the use of Prevocational Services and ensure that they support the individual's stated employment outcomes in their PCISP. The ultimate goal of these services is to develop and teach general skills that will lead to competitive and integrated employment, such as effective communication with supervisors, coworkers, and customers, and generally accepted community workplace conduct. Thank you for listening to this overview of Prevocational Services for F-S-W and C-I-H waivers. Stay tuned for the next slide.

Today, we will be discussing a document that outlines the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. The focus of our discussion will be on the P-C-I-S-P and the need for appropriate assessment and authorization. In Section 10, titled Service Definitions and Requirements for F-S-W and C-I-H Waivers, several reimbursable activities under Prevocational Services are listed. These include monitoring, training, education, demonstration, or support to assist individuals in acquiring and retaining skills in areas such as paid and unpaid training at less than 50% of the federal minimum wage, as well as generalized and transferrable employment skills acquisition. These activities can be provided through offsite enclave or mobile community work crew models. It is important to note that all Prevocational Services must be reflected in the PCISP. Additionally, these services should be reflected in the individual's plan of care as directed to habilitative rather than explicit employment objectives. This means that the focus is on developing skills and abilities rather than immediate employment opportunities. It is not expected that an individual will be able to join the general workforce or participate in sheltered employment within one year of receiving Prevocational Services. It is a process and progress towards these goals will be carefully monitored and documented. Speaking of documentation, it is crucial that Prevocational Services documentation includes the services outlined in the PCISP. In addition to this, compliance with documentation requirements outlined in 460 IAC 6 is necessary. This includes specific data elements such as the name and I-H-C-P Member ID of the individual receiving services, the name of the provider, the service rendered, the time frame of service, and the date of service including the year. It is also important to note the primary location of service delivery and provide a brief activity summary of the service rendered. Furthermore, direct care staff must document any issues or circumstances concerning the individual. Thank you for your attention to these service and documentation standards for Prevocational Services under the F-S-W and C-I-H waivers. Please continue to follow along as we discuss the remaining sections of the document. Thank you.

We are discussing the requirements for F-S-W and C-I-H Waivers Physical Therapy Services under the DDRS HCBS Waivers. There are specific guidelines and procedures for providing physical therapy services. These include the PCISP, which focuses on appropriate assessment and authorization. For Group Services, the provider must ensure that the ratio for each claimed time frame of service does not exceed the maximum allowable ratio, regardless of whether all group individuals are using a waiver funding stream. There are limitations on group sizes for Prevocational Services, with small groups having a ratio of 4:1 or smaller, medium groups having a ratio of 5:1 to 10:1, and larger groups having a ratio of larger than 10:1 but no larger than 16:1. This is a time-limited service, with a maximum of 18 months throughout a participant's time on the waiver. Exceptions to this limit will only be made on a case-by-case basis after careful consideration and alignment with the participant's individualized transition plan. Any extension of the service beyond 18 months must be accompanied by a plan for transitioning to competitive, integrated employment or another appropriate waiver service. This plan will be revisited and updated by the individual and their Individualized Support Team (I-S-T--) at least every six months, with progress toward transition as a necessary precursor for an extension. Monitoring occurs on a quarterly basis, including assessing progress towards employment goals, evaluating the appropriateness of the service, and seeking input from the individual's ISt  The main objective of monitoring is to assess the individual's progress towards achieving the outcomes outlined in their P-C-I-S-P related to employment and to verify the continued need for Prevocational Services. It is important to stay informed and adhere to these guidelines for the best care and support of our participants.

We are currently on slide 14 of the presentation, discussing the necessary requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Our focus today is on the P-C-I-S-P and the importance of appropriate assessment and authorization. To begin, we will be talking about the qualifications required for physical therapy providers under these waivers. These providers must meet the following criteria: 
 Be actively enrolled as a Medicaid provider 
 Be approved by F-S-S-A D-D-R-S 
 Comply with the guidelines set by Indiana Administrative Code, 460 I-A-C 6, including but not limited to: documentation of criminal histories, insurance, and financial status of providers. 
Additionally, they must also adhere to any applicable B-D-S service standards, guidelines, policies, and/or manuals, including FSSA DDRS policies and the module accessible on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. 
Furthermore, they must obtain and maintain accreditation from at least one of the following organizations: 
 The Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-) or its successor 
 The Council on Quality and Leadership in Supports for People with Disabilities or its successor 
 The Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O) or its successor 
 The National Committee for Quality Assurance or its successor 
 The ISO-9001 human services quality assurance (Q-A---) system 
 An independent national accreditation organization approved by the F-S-S-A Secretary 
Aside from discussing the provider qualifications, we will also touch upon the requirements for psychological therapy services under the F-S-W and C-I-H waivers. These services are provided by a licensed psychologist with an endorsement as a health service provider in psychology (H-S-P-P-), a licensed marriage and family therapist, a licensed clinical social worker, or a licensed mental health counselor. It's important to note that these services cannot be used as a substitute for those offered under the Indiana Medicaid State Plan. These waiver services are only available to individuals aged 21 and above, while medically necessary Psychological Therapy services for children under 21 are covered under the state plan benefit in accordance with the E-P-S-D-T benefit. 
To conclude, we will provide a summary of the key points discussed and answer any questions you may have. Thank you for joining us for this presentation.

We are now on our seventh slide of our presentation, where we will be discussing the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Our focus will be on the P-C-I-S-P and the need for appropriate assessment and authorization.

Under the DDRS HCBS waivers, there are certain reimbursable activities for Psychological Therapy. These include individual counseling, biofeedback, individual-centered therapy, cognitive behavioral therapy, psychiatric services, crisis counseling, family counseling, group counseling, substance abuse counseling and intervention. Additionally, planning, reporting, and write-up are also reimbursable when in association with the actual one-on-one direct care or therapy service delivery with the waiver individual.

It is important to note that therapy services should be reflected in the P-C-I-S-P of the individuals regardless of the funding source. This means that regardless of whether the service is under the Indiana Medicaid State Plan or the waiver, it must be included in the PCISP. Furthermore, these services must address the needs identified in the person-centered planning process and must complement other services received by the individuals, with the ultimate goal of increasing independence.

Moving on to documentation standards, it is crucial that all Psychological Therapy services are properly documented. This includes appropriate assessments, outlining services in the PCISP, and providing the necessary credentials for the service provider. In addition, attendance records, therapist logs, and/or charts must be kept to detail the services provided, dates, and times. It is also important to ensure that all documentation is in compliance with 460 IAC 6 Supported Living Services and Supports requirements. And finally, for those services requested on the Indiana Medicaid State Plan, it is imperative that they are also included in the PCISP.

Lastly, it is important to note that as applicable, monthly or quarterly reports must be uploaded to the document library of the state's case management system by the chosen service provider on or before the 15th day of the month. This is to ensure that all documentation is up to date and in compliance with the necessary standards.

We continue our discussion on the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Now, we turn our attention to Section 10, which focuses on service definitions and limitations. It's important to note that this waiver service is only available to individuals ages 21 and over. Any medically necessary psychological therapy services for children under the age of 21 are covered by the Indiana Medicaid State Plan benefit under the E-P-S-D-T program. 
                                    When it comes to billing for therapy services, it's important to remember that one hour of billed therapy must include a minimum of 45 minutes of direct individual care, with the remaining 15 minutes spent on related patient services. However, there are certain activities that are not allowed under Psychological Therapy. This includes activities delivered in a nursing facility, services already covered under the Indiana Medicaid State Plan (which requires a Medicaid State Plan PA denial before reimbursement can be obtained through the waiver), and therapy services provided within an educational or school setting. 
                                    It's also worth noting that services provided by the parent of a minor child or the spouse of a participant, also known as L-R-I-s-, are not allowed. This service is specifically designed to prevent duplication of therapies provided under any other service. Therefore, it is crucial that providers comply with the following qualifications. First and foremost, providers must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with Indiana Administrative Code, 460 I-A-C 6, which includes documentation of criminal histories, insurance requirements, and financial status. Additionally, providers must meet any applicable B-D-S service standards, guidelines, and policies, including FSSA DDRS policies and this module. 
                                    It's important for providers to review and fully understand these qualifications to ensure quality and appropriate services are provided to individuals. Thank you for listening and don't hesitate to reach out to us for any further clarification.

We will discuss the requirements and standards for providing physical therapy services under the F-S-W and C-I-H waivers, which is covered in slide 9 of our presentation. We will focus on the P-C-I-S-P and the importance of appropriate assessment and authorization. Recreational Therapy services fall under section 10.22 of the DDRS HCBS waivers, with a service definition outlined in 460 I-A-C 6-3-43. These services aim to restore, remediate, or rehabilitate an individual's functioning and independence, as well as reduce or eliminate the effects of their disability. Examples of reimbursable activities under Recreational Therapy include organizing and directing adapted sports, dramatics, arts and crafts, and social activities. Planning, reporting, and write-up services are also reimbursable when conducted in association with the actual one-on-one direct care/therapy service delivery with the waiver individual. We have set certain service standards for Recreational Therapy to ensure quality services for our clients. These standards should be reflected in the P-C-I-S-P and address the needs identified in the person-centered planning process. Furthermore, these services should complement other services the individual receives and promote increasing independence. Documentation standards for Recreational Therapy services include appropriate assessment, outlining services in PCISP, and providing appropriate credentials for the service provider. An attendance record should also be maintained. Thank you for your attention to this important information regarding Recreational Therapy services for the F-S-W and C-I-H waivers. On the next slide, we will discuss the documentation standards for other services provided under the Indiana Medicaid State Plan and the waiver.

We will discuss the service definitions and requirements for both F-S-W and C-I-H waivers, with a specific focus on P-C-I-S-P and appropriate assessment and authorization. Within this section, we will also mention Recreational Therapy services. However, there are limitations to these services that need to be understood. Firstly, services provided under the waiver cannot be used as a substitute for those covered under the Indiana Medicaid State Plan, ensuring that individuals receive the necessary and appropriate care for their specific needs. Additionally, group services are limited to a maximum of four individuals per recreational therapist, determined by dividing the unit rate by the number of individuals served. One hour of billed therapy service must include at least 45 minutes of direct individual care, with the remaining time spent on related individual services. Certain activities such as payment for the cost of recreational activities, registrations, memberships, or admission fees associated with the planned, organized, or directed activities are not allowed as part of Recreational Therapy. Any services that are already reimbursable through the Indiana Medicaid State Plan are not covered under this waiver. Furthermore, therapy services cannot be provided within the educational or school setting or as a component of an individual's school day. The size of group services should not exceed the maximum allowable group size determined by the Interdisciplinary Support Team (I-S-T--) for each individual in the group. Group services should only be provided when the I-S-T has determined it to be appropriate for each individual in the group, ensuring that individuals receive the most effective and personalized care. Providers of Recreational Therapy services must meet certain qualifications, including being enrolled as an active Medicaid provider and being FSSA DDRS-approved. Providers must also comply with the Indiana Administrative Code, specifically 460 I-A-C 6-10-5 D Thank you for your attention to this important information regarding Recreational Therapy services under the F-S-W and C-I-H waivers. By following these guidelines and limitations, we can ensure that individuals receive the best possible care and support.

We are now on slide number 11, out of 14, in our presentation on the DDRS HCBS Waivers. This slide covers the service definition and requirements of Remote Supports for F-S-W and C-I-H Waivers. Remote Supports is a comprehensive service that uses technology-based tools to provide live support to individuals from a remote location. This allows trained remote support professionals, or R-S-P-s-, to assist individuals instead of being on-site. The main responsibility of R-S-Ps is to provide Remote Supports from a secure remote support facility provided by the provider. To ensure the safety and confidentiality of our clients, this facility must have stable and redundant connections, including backup generators, multiple internet service connections, and battery backups. Remote Supports also includes oversight and monitoring within the residential setting for adult waiver participants and minors aged 14 to 17, through the use of technology such as two-way communication systems and sensors. It is important to note that for minors, Remote Supports are used to encourage appropriate independence, not to replace parental supervision. The ultimate goal of Remote Supports is to promote independence and security for our clients by combining technology and services to provide direct contact with trained staff whenever needed. This fosters a sense of security and allows for the development of life skills and increased independence. For those who are transitioning to independent living, Remote Supports can also assist in this process by enhancing self-advocacy skills and providing opportunities for community participation. It is important to note that Remote Supports can be used with both paid and unpaid backup support, as specified in the F-S-W and C-I-H Waivers. This ensures that our clients have the necessary support to live independently while maintaining their sense of security. Thank you for listening to this overview of Remote Supports. We will now move on to our next topic, and please feel free to ask any questions during the Q&A session at the end of the presentation.

Assessment and informed consent are critical for the provision of physical therapy services under the DDRS HCBS waivers. Careful consideration and adherence to specific standards and requirements are necessary. As described in Section 10, the unit rate for Remote Supports services is divided among the number of waiver individuals present in the home during each hour of service. This only applies to individuals who have Remote Supports included in their plan. 

In addition to this, it is imperative that the remote support system is designed and implemented with the individual's independence, health, and safety in mind. The case manager and/or B-D-S service coordinator will conduct reviews at seven and 14 calendar days after the installation to ensure that the system meets these standards. The remote support service requires both assessment and informed consent. Informed consent must be obtained from the individual using the service, their guardian, and other individuals and their guardians residing in the home. This consent must clearly state the parameters in which the remote support service will be used.

Moreover, all individuals, guardians, and I-S-T must be fully informed about the benefits and risks associated with the operating parameters and limitations of the remote support service. The remote support provider conducts an assessment, with input from the individual and their I-S-T--, to determine the best location for the devices or monitors to meet the individual's needs. The individual's personal control and use of the equipment will be reflected in their PCISP. It is the responsibility of the remote support provider to inform the individual of the equipment's operation and usage.

Finally, all informed consent documents must be acknowledged in writing and signed and dated by the individual, guardian, case manager, and provider. It is crucial to ensure that assessment and informed consent are properly obtained and considered for the successful implementation of remote support services under the DDRS HCBS waivers.

Moving on to slide number 13, we will be discussing the requirements and standards for providing physical therapy services under the DDRS HCBS waivers. Our focus will be on the P-C-I-S-P and the importance of appropriate assessment and authorization. In Section 10 of the presentation, we will outline the specific service definitions and requirements for the F-S-W and C-I-H waivers. 

When implementing a remote supports system to replace in-person direct support services, certain safeguards and backup procedures must be in place. Firstly, the provider is responsible for having backup systems (such as batteries and generators) to ensure that electronic devices remain functional during electrical outages. This applies to both the remote supports monitoring base and the individual's residential living sites. Additionally, there must be backup procedures in case of system failure, fire or weather emergencies, individual medical issues, or personal emergencies. These procedures should be documented for each site using the system, as well as for each individual's PCISP. It is crucial that these plans specify the staff members responsible for responding to these situations and traveling to the individual's living site, including any identified backup support responder. 

Furthermore, the remote supports system must be able to receive notifications from smoke or heat alarms at each individual's residential living site. This is essential for ensuring the safety and well-being of the individuals being monitored. In order to effectively interact with and address the needs of individuals in each living site, the remote supports system must have two-way audio communication capabilities. This is especially important in emergency situations where the individual may not be able to use the phone. Lastly, the system must allow the monitoring base staff to have visual oversight of specific areas in an individual's living site as deemed necessary by the ISt  

It is important to note that a remote supports monitoring base cannot be located in an individual's residential living site. This is to protect the privacy and independence of the individuals being monitored. Thank you for your attention, and now we can move on to the final slide of our presentation.

Our presentation is focused on the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers, with a specific emphasis on the P-C-I-S-P and the need for appropriate assessment and authorization. As we move to slide 14, we want to highlight the importance of real-time monitoring and backup support for individuals who receive services in their homes. The remote supports monitoring base staff will stay engaged with the individuals in their homes during urgent situations until backup staff or emergency personnel arrive. If computer vision or video is used, oversight must be done in real-time by an awake staff member at a remote location using telecommunications or broadband connections. The remote supports monitoring base must keep a file on each individual in each home monitored, including a current photograph and pertinent information to ensure their safety. This file must be updated at least annually. The remote supports monitoring base staff must also have detailed and up-to-date protocols for responding to the needs of each individual, including contact information for on-site support at their residential living site when necessary. As for backup support, the following are requirements: backup support must respond and arrive at the individual's residential living site within 20 minutes of the incident being identified by remote staff, and they must acknowledge receipt of the notification. The I-S-T has the authority to set a shorter response time based on the individual's needs. Backup support must be provided by one support person for on-site response, and the number of individuals served by that backup support must be determined by the I-S-T based on their assessed needs in specific locations. In cases where backup support is needed, they will assist the individual in their home until the urgent need or issue is resolved. If necessary, relief for backup support must be provided by the residential habilitation provider. In terms of documentation, the following must be included: